The overdiagnosis of attention deficit hyperactivity disorder (ADHD) has become a controversy as of late, as the definition for the disorder has been broadened by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) to include a larger amount of people, children in particular.
Some scientists and doctors are concerned about the risks posed by ADHD overdiagnosis, which they say could lead to unnecessary medication, as well as “devalue the diagnosis in those with serious problems,” Rae Thomas, the researcher who led a recent analysis published in the British Medical Journal, told Reuters.
“We think [the reported abuse] is more dangerous than generally believed,” Sara Jones, of the Wake Forest University School of Medicine in North Carolina, told Agence France-Presse in a phone interview.
The analysis was led by Thomas at the Centre for Research in Evidence-Based Practice at Bond University in Australia. “The broadening of the diagnostic criteria is likely to increase what is already a significant concern about overdiagnosis,” Thomas told Reuters. “It risks resulting in a diagnosis of ADHD being regarded with skepticism, to the harm of those with severe problems who unquestionably need sensitive, skilled specialist help and support.”
The authors of the analysis are merely additional voices in the overall concern about ADHD overdiagnosis and unnecessary medication. In recent years, the number of children in the U.S. diagnosed with ADHD and being treated with medication has grown dramatically. According to the Centers for Disease Control and Prevention, the percentage of kids with parent-reported ADHD diagnoses rose by 22 percent between 2003 and 2007.
Other specialists who did not take part in the British Medical Journal analysis, however, noted that underdiagnosis and undertreatment of ADHD was also a concern in some parts of the world. “I suspect that the reason for increased prescriptions of Ritalin and similar medications for ADHD has to do with better detection of the condition in children and the recognition that 50 percent or more of children with ADHD still have it as an adult,” Barbara Sahakian, professor of clinical Neuropsychology at the University of Cambridge, told Reuters.
Diagnosing ADHD is a several step process, and the criteria have been adjusted with every new version of the DSM. The most recent one, DSM-5, was released in May 2013 and made a few changes regarding ADHD criteria. Symptoms can now occur by age 12 rather than by age 6; and for adults and adolescents, only five symptoms are needed as opposed to the six needed for younger children. People with ADHD must show persistent patterns of inattention or hyperactivity-impulsivity that interferes with functioning or development, according to the DSM-5. Some of the symptoms for hyperactivity-impulsivity include fidgeting, tapping hands or feet, running about, climbing in inappropriate situations, and talking excessively.
Safe And Effective?
Medications prescribed to treat ADHD are usually stimulants like Ritalin, and while they are extremely helpful to those who are actually diagnosed with the disorder, the authors of the BMJ analysis warn that these meds can also lead to side effects like weight loss, liver toxicity, as well as suicidal thoughts. Not only are these side effects possible, but taking high doses of Ritalin may also become addictive. In a study published in 2009 in the Proceedings of the National Academy of Sciences, researchers found that Ritalin taken in doses higher than those prescribed could impact the reward region of the brain in a way similar to cocaine, affecting neuronal morphology and brain chemistry. “Methylpenidate [Ritalin] and cocaine have similar chemical structures and their pharmacological effects appear to be similar,” Yong Kim, the study’s author, told HealthDay. “Indeed, methylphenidate is widely abused for improving concentration and enhancing performance, or for recreational purposes.”
Dr. Harold Koplewicz, president of the Child Mind Institute in New York, believes that the number of children diagnosed with ADHD has risen because awareness of and a deeper understanding about the disorder has improved in the past 15 years. He says the drugs are safe and effective, helping children and adolescents diagnosed with ADHD live more focused, fruitful lives, and have better relationships. “What we don’t need is hysteria that we are handing out dangerous drugs to kids like candy,” he wrote in the Wall Street Journal.